Cardiac sonospectrographic analyzer

ABSTRACT

An apparatus, operation and method for the noninvasive diagnosis of cardiovascular disease or disorder through angiosonospectrography. Through implementation of the present invention physiological signals relating to the heart and associated blood vessels are detected, processed and identified, allowing for the early diagnosis of cardiovascular disease or disorder. An apparatus for diagnosing cardiovascular disease or disorder in accordance with the present invention includes a sensor assembly comprising a housing, and electronic module, a shock dampener, a mounting means, a piezoelectric transducer, an acoustic coupling and a back cover. The sensor assembly is connected to a data acquisition module which in turn is connected to a signal processing means, a remote connection means and a monitor. An improved acoustic coupling is disclosed that provides low-loss acoustic transmission coupling between the skin of the patient and the detector.

This application is a continuation in part of co-pending, applicationSer. No. 08/769,156 filed on Dec. 18, 1996, disclosure of which isherein incorporated by reference in its entirety.

FIELD OF THE INVENTION

This invention relates generally to an apparatus, operation and methodfor diagnosing cardiovascular disease or disorder, and morespecifically, to a non-invasive apparatus, operation and method whichprovides a means for early diagnosis and opportunity for intervention inpatients having cardiovascular disease or disorder, and which can beperformed as part of a routine physical exam.

BACKGROUND OF THE INVENTION

Heart disease kills or cripples more people in the prime of life thanall other diseases combined. Coronary artery disease is the major formof heart disease and accounts for over 67 percent of all heart diseasedeaths and heart attacks. Coronary artery disease also accounts for over70 percent of the $160 billion direct medical costs spent for heartdisease in the U.S. in 1994. Arteriosclerosis is the most common causeof this disease, with less common causes including syphilitic andrheumatic arteritis and coronary ostial obstruction associated withaortitis, embolism, periarteritis nodosa, and congenital cardiovascularanomalies. While coronary artery disease is essentially a disease ofmiddle and old age, primarily afflicting men, the disease is beingrecognized with increasing frequency in women and in the younger agegroups. Early detection of this disease would improve patient quality oflife and decrease the risk of death as it would provide the opportunityfor the effective implementation of low cost, less invasive treatment.However, even though coronary artery disease is a progressive disease itis initially diagnosed by physicians in only 17 percent of cases. Theprimary means of diagnosing this disease is due to sudden cardiac death(64 percent of cases) and acute heart attack (19 percent of cases) Wherecoronary artery disease is diagnosed by a physician, it is generallydone through the use of costly, invasive technologies, many of which usetoxic chemicals or ionizing radiation, and have considerable mortalityrisk. The diagnostic devices currently used by physicians in a normalphysical exam are almost incapable of detecting coronary artery diseaseat a point where it is almost fully treatable with drugs, exercise andlifestyle modifications.

Coronary artery disease involves a narrowing of one or both of thecoronary arteries that supply blood to the myocardium of the heart. Thisnarrowing or constriction of the artery is frequently termed a stenosis.Where a blood vessel is narrowed or partially occluded, tissues normallyserved by arterial vessels located distal from the point of stenosis canbe damaged due to the lack of sufficient blood flow. Where a stenosisoccurs in the coronary artery, the result is myocardial ischemia whichis an inadequate blood supply to the myocardium. When the coronaryartery blood flow is sufficiently reduced, the cardiac muscle is damageddue to the lack of blood supply. Coronary heart disease results when thecoronary artery restriction is sufficient to damage the cardiac muscle.Once cardiac damage has occurred the patient may experience thoracicpain known as angina pectoris. Where the damage is more extensive, thepatient may experience myocardial infarction, or heart stoppage.

Early detection of coronary artery disease allows for the effectiveimplementation of low cost, low invasion treatment modalities. However,as the coronary artery disease progresses, treatment options becomerestricted to high cost, high invasion therapies such as percutaneoustransluminal coronary angioplasty and coronary artery bypass graft.Early detection is difficult to achieve because prior to significantischemia becoming manifest, there are few if any symptoms of coronaryartery disease. Indeed, in the majority of cases, the primary diagnosticinstrument for coronary artery disease is sudden cardiac death.

In patients without symptoms the primary diagnostic instrument forcoronary heart disease has been auscultation with the traditionalstethoscope. A coronary stenosis generates a sound component that is inthe audio frequency range due to turbulent blood flow in the partiallyoccluded coronary arteries. This audio component is not present in ahealthy patient. In traditional auscultation, the physician attempts todetect and differentiate the abnormal blood flow sounds that havepathological origin from normal physiological sounds. Turbulent bloodflow in a partially occluded coronary artery generates relatively highfrequency components from about 200 hertz to about 2000 hertz withunique frequency components in the 400-1200 hertz range. Other heartsounds associated with contraction and normal heart valve operations aregenerally louder and concentrated in the lower frequency regime fromabout 10 hertz to about 200 hertz. Differentiation between these normallouder and lower frequency sounds and the abnormal weaker and higherfrequency sounds associated with coronary artery disease by auscultationwith a traditional stethoscope is very difficult, and often impossible.First, the audio component of coronary stenosis is very weak and heavilycontaminated with noise from other patient heart sounds, other normalpatient body sounds and external ambient noise in the room. Second, theaudio component of the coronary stenosis is heavily attenuated as itpasses through the patient's chest and chest wall. Additional factorsdecreasing the likelihood of coronary artery disease detection throughausculation with a traditional stethoscope included aural degredation ofthe examiner, temporal variance of the signals, frequency response ofthe stethoscope and duration of the signal associated with coronaryartery disease. The probability of detecting coronary artery diseaseusing auscultation with a traditional stethoscope is exceedingly low.There are only about a half dozen or so published accounts whereincoronary artery disease was detected by way of auscultation and thesewere only on patients with thin chest walls with the heart lying incontact with the chest wall and the disease present in the anteriorcoronary arteries.

Coronary cineangiography is another technique and method for the earlydetection of coronary artery disease. Coronary cineangiography is one ofthe most definitive procedures of detection and involves injection, byway of an anterior catheter, of a radio-opaque dye into the coronaryarteries of the patient, and then monitoring the dye through serialX-ray films. In this manner the physician can detect a narrowing, orstenosis, of the coronary arteries. It has the advantage of providinggood identification of the disease progress. However, as an invasiveprocedure, coronary angiography subjects the patient to high risk andcosts and is therefore not suitable for routine medical screening inasymptomatic patients.

Another technique, described in U.S. Pat. No. 5,159,932 to Zanetti etal., attempts to diagnose the cardiac ischemia, or insufficient bloodsupply to the cardiac muscle, through detection and display of ischemiainduced variation in the cardiac motion, which can indicate coronaryartery disease. The method of Zanetti, detects cardiac inducedcompression wave patterns at the patient's chest wall with an inertialdetector. Zanetti compares the compression wave patterns andelectrocardiogram data for pre-exercise, post-exercise and recoveryperiods.

Diagnostic methods that are used in conjunction with a "stress test" mayprove effective for early detection of coronary artery disease, however,they still require some damage or dysfunction to the heart muscle(although the damage or dysfunction may be temporary) and are notentirely suitable as a physical exam screening technique for patientswho are generally asymptomatic for coronary artery disease. Theadditional expense, time and physician effort involved in a stress test,as well as the patient discomfort, would contraindicate the use of thesetypes of methods in a normal physical exam.

Once cardiac damage has occurred, the damage can be detected throughanalysis of the patient's cardiac electrical activity under stress withan electrocardiogram. Because electrocardiogram detects damage to thecardiac muscle, and not the cardiac artery disease itself; it does notprovide a tool for early cardiac artery disease diagnosis.

A need exists for a non-invasive, low-cost and reliable means for earlydetection of cardiovascular disease or disorder, allowing for earliertherapeutic intervention.

DESCRIPTION OF RELATED ART

Because of the significantly greater amplitude of lower frequency heartsounds, the higher frequency, lower amplitude sounds related to coronaryartery disease may not be audible at all. U.S. Pat. No. 4,528,690 toSedgwick, U.S. Pat. No. 3,790,712 to Andries; and U.S. Pat. No.3,160,708 to Andries et al. disclose relatively simple electronicstethoscopes as methods for amplification of the sounds in an attempt toraise the sub-audible components into the audible range. However, simpleamplification of the entire frequency spectrum, as disclosed, can causethe louder lower frequency heart sounds to mask or drown out the weakersounds resulting from coronary artery disease. This is particularlytroublesome when the relative amplitudes of the low and high frequencysounds are separated by many decibels. In addition, the louder soundsmay overdrive a simple amplifier.

To this end, U.S. Pat. No. 4,594,731 to Lewkowicz and U.S. Pat. No.5,347,583 to Dieken et al. disclose various forms of selective filteringor signal processing on the audio signal in the electronic stethoscope.Lewkowicz discloses a means for shifting the entire detected spectrum ofsounds upward while expanding the bandwidth so that they are more easilyperceived by the listener. Dieken et al. discloses an electronicstethoscope having a greater volume of acoustic space and therebyimproving low frequency response. Dieken is specifically directed toenhancement of the lower frequency spectrum between 30 and 50 hertz,rather than the higher frequency spectrum required for detection ofcoronary artery disease.

The electronic stethoscope provides a moderate improvement overconventional methods of auscultation. However, information remains inaudio form only and is transient; the physician is unable to visualizethe data and either freeze the display or focus on a particular elementof the signal retrieved. To accommodate that deficiency, the techniqueof phonocardiography, which is the mechanical or electronic registrationof heart sounds with graphic display, is used. U.S. Pat. No. 5,218,969to Bredesen et al.; U.S. Pat. No. 5,213,108 to Bredesen et al.; U.S.Pat. No. 5,012,815 to Bennett, Jr. et al.; U.S. Pat. No. 4,967,760 toBennett, Jr. et al.; U.S. Pat. No. 4,991,581 to Andries; and U.S. Pat.No. 4,679,570 to Lund et al. disclose phonocardiography with signalprocessing and visual/audio output. U.S. Pat. No. 5,301,679 to Taylor;and U.S. Pat. No. 4,792,145 to Eisenberg et al. disclosephonocardiography with signal processing and visual display.

The process of phonocardiography as commonly known in the art, acquiresacoustic data through an air conduction microphone strapped to apatient's chest, and provides the physician with a strip chart recordingof this acoustic data. The strip chart is generally created at a rate of100 mm/second. As this method is normally used, with the exception ofthe created strip chart, data is not stored. Thus, it is not possible tomanipulate and/or process the data post acquisition. In addition,phonocardiography does not provide the sensitivity or dynamic rangeneeded to monitor softer physiological sounds such as the higherfrequency sounds due to the blood turbulence associated with stenosis.

As previously noted, one problem in traditional auscultation is ambientnoise from the environment which reduces the signal to noise ratio ofthe sounds of interest. U.S. Pat. No. 4,672,977 to Kroll discloses amethod for automatic lung, sound cancellation and provides visual andaudio output. U.S. Pat. No. 5,309,922 to Schecter et al. discloses amethod for cancellation of ambient noise to enhance respiratory soundsand provides visual and audio output. U.S. Pat. No. 5,492,129 toGreenberger discloses a method for reducing general ambient noise andprovides audio output.

U.S. Pat. No. 5,036,857 to Semmlow et al. discloses a method ofphonocardiography with piezoelectric transducer. Semmlow specificallyrecommends against Fast Fourier Transformation analysis of thephonocardiography data and relies on processing by other means. U.S.Pat. No. 5,109,863 to Semmlow et al.; and U.S. Pat. No. 5,035,247 issuedto Heimann also disclose piezoelectric transducers.

U.S. Pat. No. 5,002,060 to Nedivi, discloses both heart and respiratorysensors, with Fast Fourier Transformation analysis. In the techniquedisclosed by Nedivi the sensors are not physically attached to thepatient. Thus the sensors are not capable of detecting the low intensitysound of the blood turbulence associated with stenosis.

Devices currently known in the art do not provide a non-invasive,low-cost and reliable means for early detection of cardiovasculardisease or disorder. Additionally, the related art does not provide thelevel of aural sensitivity needed to reliably detect the sounds relativeto and indicative of cardiovascular disease or disorder.

What is needed is a safe, sensitive, inexpensive and noninvasive meansof diagnosing cardiovascular disease or disorder. This is accomplishedthrough the present invention. The use of sonospectrography as disclosedin the present invention allows for the early detection, diagnosis andopportunity for intervention in patients with no symptoms or signs ofcardiovascular disease or disorder. Further embodiments of the presentinvention provide a means of detecting physiological sounds, such assounds emitted by the heart and other body organs as well as soundsrelated to the flow of blood through the circulatory system. Analysis ofthese sounds can be used to determine relative systemic and pulmonaryblood pressure, monitor anesthesiology, assess cardiac output, monitorthe circulation of diabetic individuals and monitor fetal heartbeat aswell as detect conditions such as aneurysms, arterial occlusions,arthritic decrepitation, phlebitis, venous thrombosis, intravascularblood clotting, and carotid artery disease. Sonospectrography is definedas the separation and arrangement of the frequency components ofacoustic signals in terms of energy or time. Angiosonospectrography isdefined as the separation and arrangement of the frequency components ofacoustic signals created by hemodynamic turbulence in the flow of bloodthrough bodily blood vessels; the purpose of which is the detection andclinical correlation with normal/abnormal physiological states.

SUMMARY OF THE INVENTION

It is therefore an object of the present invention to provide anapparatus, operation and method for the detection and analysis ofphysiological sounds, such as sounds emitted by the heart and other bodyorgans as well as sounds related to the flow of blood through thecirculatory system.

It is a further object of the present invention to provide anon-invasive apparatus, operation and method to be used to determinesystemic and pulmonary blood pressure, monitor anesthesiology, determinecardiac output, monitor the circulation of diabetic individuals andmonitor fetal heartbeat as well as detect conditions such as aneurysms,arterial occlusions, arthritic decrepitation, phlebitis, venousthrombosis, intravascular blood clotting, and carotid artery disease.

It is a further object of the present invention to provide thisapparatus, operation and method through the use ofangiosonospectrography.

It is a further object of the present invention to provide thisapparatus, operation and method through a synchronized and coordinatedcombination of angiosonospectrography and electrocardiogram signals.

It is a further object of the present invention to provide thisapparatus, operation and method through visual display means thatprovide insight to the subtle characteristics of the acoustic signaturesof physiological origin.

It is a further object of the present invention to provide thisapparatus, operation and method through selective time and frequencywindowing of the acoustic signals.

It is a further object of the present invention to provide thisapparatus, operation and method through real-time signal processing orrecorded-signal post processing.

It is a further object of the present invention to provide thisapparatus, operation and method through use of single or multipletransducers.

It is a further object of the present invention to provide thisapparatus, operation and method through a computer assisted searchalgorithm to identify optimal placement of the transducer(s) on thepatient.

It is a further object of the present invention to provide thisapparatus, operation and method in office environments with moderate tohigh ambient noise levels, through adaptive noise cancellationtechniques.

It is a further object of the present invention to provide thisapparatus, operation and method in a form that provides for dynamictemplate building to facilitate disease detection and identification.

It is a further object of the present invention to provide thisapparatus, operation and method through neural network techniques.

It is a further object of the present invention to provide an acousticcoupling that minimizes signal loss between the subject-detectorinterface and allows for the detection of sounds heretofore undetectablein a normal room environment.

It is a further object of the present invention to extend the ability ofclinicians to analyze sounds which are lower in intensity than thosedetectable by the unaided ear.

It is a further object of the present invention to extend the ability ofclinicians to analyze sounds which are lower in frequency than thosedetectable by typical auscultation techniques and instruments.

It is a further object of the present invention to increase detection ofa specified frequency range through the use of a tailored bandpassamplifier.

It is a further object of the present invention to provide a means fordata storage, data manipulation and data transmission.

It is a further object of the present invention to provide anon-invasive apparatus, operation and method that is suitable forroutine physical examination screening and early diagnosis ofcardiovascular disease or disorder in patients with no symptoms or signsof disease or disorder, thereby providing an opportunity for earlyintervention to extend the patient's productive life.

It is a further object of the present invention to provide thisapparatus, operation and method through advanced processing of theacoustic signals in the time and frequency domain to isolate and displaythe abnormal lower intensity, higher frequency sound componentsassociated with coronary artery disease from the stronger, lowerfrequency components associated with normal cardiac sounds.

It is a further object of the present invention to provide thisapparatus, operation and method in a form that is adaptable to detectionof partial blockage in other critical arterial or venous regions.

It is a further object of the present invention to provide thisapparatus, operation and method with a transducer that accurately andreliably captures the abnormal higher frequency components of arterialblockage associated with cardiovascular disease.

These and other objects of the present invention will become obvious tothose skilled in the art upon review of the following disclosure.

An apparatus for diagnosing cardiovascular disease or disorder inaccordance with the present invention includes a sensor assemblycomprising a housing, an electronic module, a shock dampener, a mountingmeans, a transducer, an acoustic coupling and a back cover. The sensorassembly is connected to a data acquisition module which in turn isconnected to a signal processing means. The signal processing means isconnected to an electronic storage means, a hard copy reproductionmeans, a remote connection means and a monitor. In an alternativeembodiment of the invention a plurality of sensor assemblies areconnected to the data acquisition module. In another alternativeembodiment of the invention a means for determining an electrocardiogramis connected to the signal processing means. In yet another alternativeembodiment of the invention, the data acquisition module is connected tohigh-fidelity earphones.

The operation for diagnosing cardiovascular disease or disorder inaccordance with the present invention includes:

1) performing start-up procedures;

2) acquiring physiologic signals;

3) acquiring ambient or background signals;

4) processing and subtracting ambient signals from physiologic signals;

5) conditioning and processing resultant data;

6) subjecting the conditioned and processed data to Fast FourierTransformation;

7) passing the time domain components of the data through a time domaincorrelator and feature extraction process;

8) passing the frequency domain components of the data through afrequency domain correlator and feature extraction process;

9) comparing the time domain output and the frequency domain output to areference pattern and feature library;

10) determining whether the time domain output and frequency domainoutput match known disease modalities;

11) determining whether a disease condition or state is indicated;

12) updating the reference pattern and feature library; and

13) providing the information regarding the disease modality to thephysician so that a treatment regimen may commence.

The method for diagnosing cardiovascular disease or disorder, inaccordance with the present invention includes monitoring thephysiologic sounds being emitted from diseased coronary arteries, using,the apparatus of the present invention. This is done by placing theacoustic transducer of the sensor assembly in contact with the specificlocations of the patient's skin. The patient's heart, circulatory andrespiratory sounds are acquired while the patient is breathing normally.Detected signals are manipulated in the same fashion noted in the"operation" of the present invention. The signals can be viewed andanalyzed by medical personnel at any number of points during this datamanipulation process to allow for the implementation of a treatmentregimen.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic representation of the overall architecture anduser interface of the present invention.

FIG. 2a depicts an exploded, oblique view of the sensor assembly.

FIG. 2b depicts an exploded, side view of the sensor assembly.

FIG. 3 depicts an exploded, oblique view of an alternative embodiment ofthe sensor assembly.

FIG. 4 depicts a circuit diagram of the electronic module, data cableand data acquisition module.

FIG. 5 depicts a circuit diagram of greater detail, comprising theelectronic module, data cable and data acquisition module.

FIG. 6 depicts a circuit diagram of still greater detail, comprising theelectronic module, data cable and data acquisition module.

FIG. 7 depicts an idealized tailored bandpass amplifier response.

FIG. 8 depicts the frequency response of a tailored bandpass amplifier,plotting amplitude versus frequency.

FIG. 9 illustrates the simultaneous display of electrocardiogram andacoustic signal data.

FIG. 10a illustrates an acoustic amplitude vs. time display mode.

FIG. 10b illustrates a relative amplitude vs. frequency display mode.

FIG. 10c illustrates a frequency vs. time display mode.

FIG. 11 is a flow chart illustrating the operation of the presentinvention.

FIG. 12 depicts suggested transducer locations for the screening ofcardiovascular disease or disorder.

FIG. 13a depicts data indicative of coronary artery disease, prior tosignal processing.

FIG. 13b depicts data indicative of coronary artery disease, post signalprocessing.

FIG. 14a depicts a digital image of a normal heart sound pattern.

FIG. 14b depicts a digital image indicative of coronary heart disease.

FIG. 15 depicts time series data indicative of common abnormal heartsounds.

FIG. 16 depicts cardiac sonospectrographic data.

DETAILED DESCRIPTION

The present invention provides an apparatus, operation and method topassively and non-invasively detect cardiovascular disease or disorderthrough detection, identification and characterization of the acousticsignature associated with cardiac and circulatory sounds.

APPARATUS

Referring to FIG. 1, the overall architecture of the present inventionis described. Patient physiologic signals, such as acoustic vibrationsor electrical impulses, are detected by sensor assembly 102. In analternative embodiment a plurality of sensor assemblies can be used toeither simultaneously obtain signals from various locations of the bodyor to simultaneously obtain signals from both the patient and theenvironment. Sensor assembly 102 is connected to data acquisition means103.

Data acquisition means 103 comprises preamplifier 114, audio amplifier116, and analog-to-digital converter 118. Preamplifier 114electronically isolates the transducer, detects the electronic signals,and sends them to audio amplifier 116 and to analog-to-digital converter118. Audio amplifier 116 drives one or more sets of high-fidelityearphones 120. Analog-to-digital converter 118 samples the analog signaland converts it to a binary number for each time sample. Dataacquisition means 103 is connected to signal processing means 104.

Signal processing means 104 is a general-purpose microprocessor. Signalprocessing means 104, also has means for video display of information,such as monitor 112. Signal processing means 104 is connected toelectronic data storage means 106, operator input means 107, hard copyreproduction means 108 and remote connection means 110.

Various types of electronic data storage are known to those skilled inthe art. In alternative embodiments electronic data storage means 106comprises: internal hard disk drive, external hard disk drive, floppydisks, digital audio tape, magneto-optical storage or CD ROM. Likewise,various types of operator input means are known to those skilled in theart. In alternative embodiments operator input means 107 comprises:keyboard, mouse, voice detector or other means. Hard copy reproductionmeans 108 provides copies of images displayed on monitor 112 forpurposes such as maintaining medical records, assisting consultations,and assisting data processing and review. Remote connection means 110 isa modem. In alternative embodiments, the system of the present inventionmay be directly linked to a network via a network interface card orother suitable means. Thus a modem may not always be necessary.

In an alternative sensor assembly embodiment, sensor assembly 102 candetect both physiologic and background signals. In another alternativesensor assembly embodiment, one side of sensor assembly 102 comprises anaudio transducer which is in contact with the skin while a second audiotransducer on the opposite side faces away from the patient. This secondtransducer is designed to acquire ambient sounds in synchronism with thesounds reaching the transducer in contact with the patient's skin toreject common mode signals reaching both transducers. By adding theenvironmental signals out of phase with the signals acquired from thepatient, the sounds in common to both transducers are effectivelycanceled. In yet another alternative sensor assembly embodiment thetarget frequency range for data acquisition is about 200 to 2000 Hz. Inanother alternative sensor assembly embodiment, the target frequencyrange for signal acquisition is about 400 hertz.

In an alternative preamplifier embodiment, preamplifier 114 demonstrateslow-noise data acquisition and proper impedance matching.

In an alternative analog-to-digital converter embodimentanalog-to-digital converter 118 has a sample rate about 4 to 48 Khz. Inyet another alternative analog-to-digital converter embodiment,analog-to-digital converter 118 has a sample rate of about 44 Khz. Inanother alternative analog-to-digital converter embodiment,analog-to-digital converter 118 has a resolution of about 16 bits. Inyet another alternative analog-to-digital converter embodiment,analog-to-digital converter 118 has a linearity about ±0.005 percent offull scale. In another alternative analog-to-digital converterembodiment, analog-to-digital converter 118 has a sample length of aboutone to sixty seconds. In yet another alternative analog-to-digitalconverter embodiment, analog-to-digital converter 118 has an operatorselectable sample length.

In an alternative earphones embodiment, earphones 120 have separatevolume controls.

In an alternative signal processing means embodiment, signal processingmeans 104 is a computer with a central processing unit. In anotheralternative signal processing means embodiment, signal processing means104 is an IBM compatible personal computer using an INTEL processor(386, 486, Pentium), having a minimum of 8 MB RAM memory and a minimumhard disk size of 500 MB. In yet another alternative signal processingmeans embodiment, signal processing means 104 is a Macintosh PowerPC.

In an alternative monitor embodiment, monitor 112 has a minimum displaysize of 600×400 pixels and a minimum monitor 112 display depth of eightbits. In yet another alternative monitor embodiment, monitor 112 is ahigh resolution EGA or VGA color display monitor.

In an alternative signal processing means embodiment, signal processingmeans 104 comprises a sound card. In another alternative signalprocessing means embodiment, the sound card comprises a "Tahiti"multiple channel computer sound card manufactured by Turtle Beach,although sound cards such as the Pro Audio 1b (Media Vision) can also beused.

In an alternative hard copy reproduction means embodiment, hard copyreproduction means 108, is a printer. In another alternative hard copyreproduction means embodiment, hard copy reproduction means 108 is aprinter capable of generating a variety of different graphic displays.In yet another alternative hard copy reproduction means embodiment, hardcopy reproduction means 108 is a laser printer.

In an alternative remote connection means embodiment, remote connectionmeans 110 is an internal or external, high speed modem. In anotheralternative remote connection means embodiment, remote connection means110 has a speed of at least 14.4 kilobytes per second.

Referring to FIG. 2a, an oblique view of an embodiment of sensorassembly 102 is shown. FIG. 2b depicts a side view of an embodiment ofsensor assembly 102. Housing 302 comprises a sound deadening materialhaving sufficient mass to dampen high frequency ambient disturbances andhold the sensor assembly in contact with the patient through gravity.Housing 302 has housing front 304 and housing back 306. Rim 308 islocated on the periphery of housing front 304. First indentation 310runs parallel and adjacent to the inside of rim 308. Second indentation312 runs parallel and adjacent to the inside of first indentation 310.Bore 312 is approximately centrally located within second indentation312 and is shaped and sized in conformity to the shape and size ofelectronic module 314. Electronic module 314 nests within bore 312 ofhousing 302. As will be further discussed, signal detection andprocessing circuitry are incorporated within electronic module 314.

Shock dampener 316 is positioned adjacent to first indentation 310.Mounting means 318 is positioned adjacent to shock dampener 316.Transducer 320 is positioned within mounting means 318. Transducer 320converts detected signals into electronic signals. Acoustic coupling 322is positioned adjacent to transducer 320. Acoustic coupling 322 servesto dilinearize excitation response and reduce dynamic range.

Once assembled, housing 302 is closed to the ambient environment withback cover 324. Sensor assembly 102 comprising all the individual sensorelements, is assembled and sealed to form a single complete unit.

In an alternative housing embodiment, housing 302 is composed of nickelplated aluminum, but can be any material having sufficient mass todampen high frequency ambient disturbances and hold the sensor incontact with the patient through gravity.

In an alternative sensor assembly embodiment, when electronic module 314nests within bore 312 of housing 302, top 316 of electronic module 314is flush with second indentation 312.

In an alternative shock dampener embodiment shock dampener 316 is an "O"ring.

In an alternative mounting means embodiment, mounting means 318 is aplastic mounting ring.

In an alternative transducer embodiment, transducer 320 is apiezoelectric disk. In another alternative transducer embodiment,transducer 320 has a high impedance. In yet another alternativetransducer embodiment, transducer 320 has an impedance of about 470Kohms. In another alternative transducer embodiment, transducer 320 hashigh efficiency as compared with conventional electromagnet typespeakers. In yet another alternative transducer embodiment, transducer320 is ultra thin and lightweight. In another alternative transducerembodiment, transducer 320 has a frequency range of about 500-20,000 Hz.In yet another alternative transducer embodiment, transducer 320 has acapacitance at 120 Hz of about 60±30% nF. In another alternativetransducer embodiment, transducer 320 current leakage is limited toabout one micro ampere.

In an alternative acoustic coupling embodiment, acoustic coupling 322 isimpedance matched, and serves to provide a low-loss acoustictransmission coupling between the skin of the patient and transducer320, thereby minimizing signal loss across the subject-detectorinterface.

In another alternative acoustic coupling embodiment, acoustic coupling322 is a parametric acoustic transconductor. In yet another acousticcoupling embodiment, acoustic coupling 322 has a high conductioncoefficient. In another alternative acoustic coupling embodiment,acoustic coupling 322 is made of latex foam. In yet another alternativeacoustic coupling embodiment, acoustic coupling 322 is logarithmicallyattenuated, having low transmission at low frequencies and hightransmission at high frequencies.

Referring to FIG. 3 an oblique exploded view of an alternativeembodiment of sensor assembly 102 is shown. Housing 402 comprises asound deadening material having sufficient mass to dampen high frequencyambient disturbances and hold the sensor assembly in contact with thepatient through gravity. Housing 402 has housing front 404 and housingback 406. First rim 408 is located on the periphery of housing front404. Second rim 410 is located on the periphery of housing back 406.First indentation 412 runs parallel and adjacent to the inside of firstrim 408. Second indentation 414 runs parallel and adjacent to the insideof first indentation 412. Third indentation 416 runs parallel andadjacent to the inside of second rim 410. Fourth indentation 418 runsparallel and adjacent to the inside of third indentation 416. First bore420 is approximately centrally located within second indentation 414 andis shaped and sized in conformity to the shape and size of firstelectronic module 422. Second bore 440 is approximately centrallylocated within fourth indentation 418 and is shaped and sized inconformity to the shape and size of second electronic module 442. Firstelectronic module 422 nests within first bore 420 of housing 402. Secondelectronic module 442 nests within second bore 440 of housing 402. Aswill be further discussed, signal detection and processing circuitry areincorporated within first and second electronic module 422, 442.

First shock dampener 424 is positioned adjacent to first indentation412. Second shock dampener 426 is positioned adjacent to thirdindentation 416. First mounting means 428 is positioned adjacent tofirst shock dampener 424. Second mounting means 430 is positionedadjacent to second shock dampener 426. First transducer 432 ispositioned within first mounting means 428. Second transducer 434 ispositioned within second mounting means 430. First transducer 432,converts detected physiologic signals into electronic signals. Secondtransducer 434, converts detected environmental or background signalsinto electronic signals. First acoustic coupling 436 is positionedadjacent to first transducer 432. Second acoustic coupling 438 ispositioned adjacent to second transducer 434. First and second acousticcoupling 436, 438 serve to dilinearize excitation response and reducedynamic range.

In an alternative housing embodiment, housing 402 is composed of nickelplated aluminum.

In an alternative shock dampener embodiment, first and second shockdampener 424, 426 is an "O" ring.

In an alternative mounting means embodiment, first and second mountingmeans 428, 430 is a plastic mounting ring.

In an alternative transducer embodiment, first and second transducer432, 434 is a piezoelectric disk. In another alternative transducerembodiment, first and second transducer 432, 434 has a high impedance.In yet another alternative transducer embodiment, first and secondtransducer 432, 434 has an impedance of about 470 Kohms. In anotheralternative transducer embodiment, first and second transducer 434, 434has high efficiency as compared with conventional electromagnet typespeakers. In yet another alternative transducer embodiment, first andsecond transducer 432, 434 is ultra thin and lightweight. In anotheralternative transducer embodiment, first and second transducer 432, 434has a frequency range of about 5-2,000 Hz.

In yet another alternative transducer embodiment, first and secondtransducer 432, 434 has a capacitance at 120 Hz of about 60±30% nF. Inanother alternative transducer embodiment, first and second transducer432, 434 current leakage is limited to about one micro ampere.

In an alternative acoustic coupling embodiment, first and secondacoustic coupling 436, 438, is impedance matched, and serves to providea low-loss acoustic transmission coupling between the skin of thepatient and first transducer 432, thereby minimizing signal loss acrossthe subject-detector interface. In another alternative acoustic couplingembodiment, first and second acoustic coupling 436, 438 is a parametricacoustic transconductor. In yet another acoustic coupling embodiment,first and second acoustic coupling 436, 438 has a high conductioncoefficient. In another alternative acoustic coupling embodiment, firstand second acoustic coupling 436, 438 is made of latex foam. In yetanother alternative acoustic coupling embodiment, acoustic coupling 322is logarithmically attenuated, having low transmission at lowfrequencies and high transmission at high frequencies.

Referring to FIG. 4, electronic module 314, transducer 320, data cable502, and data acquisition module 504 of the present invention are shownin schematic form. In combination, first resistor 506, semiconductordevice 508, second resistor 510, and first capacitor 512 compriseelectronic module 314. Electronic module 314 performs functions such assignal amplification, and filtering. Transducer 320 is connected inparallel with first resistor 506, second resistor 510, first capacitor512, and semiconductor 508. Semiconductor 508 serves to modulatecurrent. First capacitor 512 provides gain and source decoupling forsemiconductor 508.

In an alternative first resistor embodiment, first resistor 506 providesa matching load to transducer 320. In another alternative first resistorembodiment first resistor 506 has a resistance of 470 Kohms.

In an alternative second resistor embodiment, second resistor 510 isabout 10 Kohms.

In an alternative semiconductor embodiment, semiconductor 508 is fieldeffect transistor. In another alternative semiconductor embodiment,semiconductor 508 is a field effect transistor with an N-type base.

In an alternative first capacitor embodiment, first capacitor 512 is 60microfarads and is connected to ground.

FIG. 5 depicts a circuit diagram of the electronic module, data cableand data acquisition module in greater detail. The circuit compriseselectronic module 314, transducer 320, data cable 502, and dataacquisition module 504. Data cable 502 couples electronic module 314 todata acquisition module 504. Data acquisition module 504 comprises anamplifier. As depicted in FIG. 5, highpass filter 606 is followed bylowpass filter 608 having a DC injection point. The amount of DCinjection is made variable by value selection of variable resistor 610.In an alternative value selection embodiment, value selection isdetermined by the practitioner. In yet another alternative valueselection embodiment, value selection is determined automatically by thesignal processing means in conformity with predetermined parameters.

In an alternative data cable embodiment, data cable 502 is twisted pair602, wherein two insulated wires are twisted forming a flexible linewithout the use of spacers. In another alternative data cableembodiment, data cable 502 is shielded pair 604, wherein two parallelconductors are separated from each other and surrounded by a soliddielectric. In this alternative embodiment, the conductors are containedwithin a copper-braid tubing that acts as a shield. The assembly iscovered with a rubber or flexible composition coating to protect theline against moisture and friction. There are two advantages of thisalternative embodiment: (1) the capacitance between each conductor andground is uniform along the entire length of the line; and (2) the wiresare shielded against pickup of stray electric fields. In yet anotheralternative embodiment shielded pair 604 data cable 502 is connected tosensor housing 610 and to ground as a means for reducing electricalnoise and increasing patient safety.

In an alternative data acquisition module embodiment, data acquisitionmodule 504 has a low frequency response from about 10 Hz to a crossoverpoint at 100 Hz, rising to a level 20 dB higher from about 600 Hz to 2KHZ, then declining steadily beyond that point. In another alternativedata acquisition module embodiment, data acquisition module 504comprises a voltage gain, variable from zero to fifty, allowing recoveryof low-level sounds from 600 to about 2000 Hz while preserving theability to measure low-frequency signals having a relatively highamplitude, without amplifier saturation.

In an alternative highpass filter embodiment, highpass filter 606 has again of about 7, and lowpass filter 608 drives an output amplifier witha gain of about 7. In another alternative highpass filter embodiment theoverall voltage gain available with the gain potentiometer at maximumwill be about 50. An advantage of this alternative embodiment is theability to reject a narrow range of frequencies in a notch caused by thephase delay in the components of highpass filter 606. In an alternativehighpass filter embodiment this notch is set at 100 Hz. In anotheralternative highpass filter embodiment this notch is set at about 50-60Hz, thereby providing a measure of hum rejection.

FIG. 6 depicts a circuit diagram of the electronic module, data cableand data acquisition module in greater detail. The circuit compriseselectronic module 314, transducer 320, data cable 502, and dataacquisition module 504. Three stage resistor/capacitor network 702 givesa total of about 180 degrees of phase shift at a design frequency ofabout 100 Hz that is related to the combined resistor/capacitor timeconstants of the network. Field effect transistor 508 input isAC-coupled to the four-pole lowpass filter 608 formed by a single747-type operational amplifier pair.

FIG. 7 depicts an idealized shape of an amplifier having low-frequencyresponse from first point 802 to crossover point 804 and having higherfrequency response of predetermined level 806, from second point 808 tothird point 810. In an alternative embodiment, first point 802 is about10 Hz, crossover point 804 is about 100 Hz, predetermined level 806 isabout 20 dB, second point 808 is about 600 Hz and third point 810 isabout 2 Khz. In yet another alternative embodiment, crossover point 804is about 60 Hz.

FIG. 8 further depicts the response of the tailored bandpass amplifier,plotting amplitude 902 vs. frequency 904 of basic heart sounds 906 andsounds of interest 908. In alternative embodiments, the response ofsounds of interest 908 may be set at varying levels 910.

FIG. 9 depicts the simultaneous display of electrocardiogram andsonospectrography data. In the simultaneous display mode, the presentinvention provides for plotting electrocardiogram data andsonospectrography data as a function of intensity 1002 and time 1004,with digital markers 1006 to allow the visual correlation of points ofsignal activity that may be common to both signals. As an example, theelectrocardiogram pulse at 1008 can be visually correlated with a selectpart of the acoustic signal 1010 and differentially measured to within23 millionths of a second. This allows an operator who may be lessfamiliar with acoustic signatures to correlate the electrocardiogramsignal, which may be well understood, with the acoustic signal.

Referring to FIGS. 10a, 10b, and 10c, the display methodology of thepresent invention is shown. The present invention provides a means tosimultaneously display the signal of interest in a variety of differentforms. In FIG. 10a, the signal of interest of the present invention ispresented as a simple time series, with acoustic amplitude 1102 on thevertical scale and time 1104 on the horizontal scale. In FIG. 10b, thesignal of interest of the present invention is presented as a time andfrequency display, with relative amplitude 1106 of each slice of thefrequency spectrum on the vertical scale and frequency spectrum 1108 onthe horizontal display. In FIG. 10c, the signal of interest of thepresent invention is presented with frequency 1110 on the vertical axis,time 1112 on the horizontal axis, and relative amplitude plotted indifferent color hues (not shown) and/or grey scale intensity.

Having thus described the basic concept of the apparatus of theinvention, it will be readily apparent to those skilled in the art thatthe foregoing detailed disclosure is intended to be presented by way ofexample only, and is not limiting. Various alterations, improvements andmodifications will occur and are intended to those skilled in the art,but are not expressly stated herein. For example, while cardiovascularmonitoring is a key aspect of the invention, the techniques describedherein are equally applicable to the monitoring of other body organs andregions of the body of both humans and animals and thus may also findutility in the veterinary sciences. These modifications, alterations andimprovements are intended to be suggested hereby, and are within thespirit and scope of the invention.

OPERATION

FIG. 11 depicts the operation of the apparatus of the present inventionwith associated hardware and software. At step 1202, start-up proceduresare performed such as initialization, calibration, sensor selection,patient parameter input, and buffer clearing, among others. Uponcompletion of these start-up procedures steps 1204 and 1206 areinitiated. At step 1204, sensor 102 provides patient physiologic signalsfor signal processing. In an alternative embodiment, sensor 102 caninclude electrocardiogram sensors and acoustic sensors. At step 1206acoustic sensors are used to detect background or ambient noise.

Next, at step 1208, the detected signals are passed to individual dataacquisition modules which contain means for signal filtering, impedancematching, amplification, and buffering. These functions are performed bythe components of the circuitry illustrated in FIGS. 4-6.

At step 1210, the signals from the ambient noise acoustic sensoracquired in step 1206, are processed and subtracted from the signalsfrom the desired sensor of step 1204 in a noise cancellation process toreduce the effect of ambient noise from the patient's environment.

At step 1212, the signal undergoes additional signal conditioning andprocessing. The purpose of this conditioning step is to convert theanalog signal to digital, provide adjustable decimation with a samplingrate suitable to avoid biasing, provide adjustable smoothing, averagingand peak holding. In an alternative embodiment the signal conditioningand processing of step 1212 is performed by a sound card which typicallyhas the following capabilities: (1) a sample rate selectable from about4 K to 44 K; (2) a sample size of about 16 bits; (3) capable of analogto digital conversion; (4) capable of digital to analog conversion; and(5) possesses IBM computer bus compatibility such as ISA, EISA, PCI,etc. In yet another alternative embodiment the sound card used comprisesa "Tahiti" multiple channel Sound Card manufactured by Turtle Beach.Step 1230 allows for the intermediate output and display of the desiredsignal following the signal conditioning and processing of step 1212.The display is accomplished by selection of a desired display mode andsubsequent display on the monitor 112. The output of step 1212 is of atime series and is suitable for display selection as in FIG. 10a.

At step 1214, the digitized and conditioned data is subjected to asliding fast Fourier transformation. The output of step 1214 is of timeand frequency and is suitable for display selection according to FIGS.10b or 10c.

At step 1216, time domain components of the data passes through a timedomain correlator and feature extraction process. In a similar fashion,in step 1218, the frequency domain components of the data passes througha frequency domain correlator and feature extractor. In step 1220, theoutputs from the time domain correlator and feature extraction processof step 1216 and the frequency domain correlator and feature extractorof step 1218 are compared to a reference pattern and feature library, todetermine whether the features contained within the signal of interestmatch known disease modalities as recorded and maintained within thereference pattern and feature library.

At step 1222, the outputs from the time domain correlator and featureextraction process of step 1216, the frequency domain correlator andfeature extractor process of step 1218 and the results from thereference pattern and feature library comparison of step 1220 aresubjected to a recognition logic decision, where a determination is madeas to whether a disease or adverse condition is indicated. At step 1224,the new disease modality indicated in the recognition logic decision ofstep 1222 is then used to update the reference pattern and featurelibrary of step 1220. In step 1226 a desired display mode such asdepicted in FIGS. 10a, 10b and 10c is chosen for subsequent display onthe monitor 112. At step 1228 the process is either terminated at step1240 or begun anew at step 1202.

The preceding descriptions of the operation of the present invention aremerely illustrative. In various embodiments of the disclosed inventionoperational steps may be added, eliminated, performed in parallel orperformed in a differing order.

METHOD

Sonospectrography can be used as a primary source of auscultatoryinformation in a routine physical examination or in populationscreening. Sonospectrography can be used in cardiology and generalmedicine for the detection of functional and organic disorders of theheart such as congenital defects, valve function, diseases of thepericardium and myocardium and systemic and pulmonary hypertension.Sonospectrography can also be used as a traditional stethoscope tocapture sounds generated by other organs, such as the lungs, trachea,larynx, liver and carotid arteries.

A wealth of clinical information can be derived throughsonospectrography of the sounds of the heart. This includes informationpertaining to function and state of the myocardium, function and stateof the heart valves, heart rate variability and periodicity,hemodynamics of blood flow, blood pressure and hypertension factors,blood chemistry factors, pharmacologic effects, endocrine functions,coronary neural network state, precordial abnormalities, probability ofcoronary infarction or stroke, respiratory and pulmonary abnormalitiesand coronary artery disease.

In cardiac sonospectrographic analysis, a sensor assembly is placed incontact with the patient. One side of the sensor assembly contains anacoustic coupler that is placed in contact with the patient's skin,while a second acoustic coupler on the opposite side faces away from thepatient. This second transducer is designed to acquire ambient sounds insynchronism with the transducer coupled to the patient's skin to rejectcommon mode signals reaching both couplers. While breathing normally,the patient's heart and respiratory sounds are acquired, preamplifiedand sent to a plurality of locations. FIG. 12 depicts suggestedtransducer locations for identifying cardiovascular disease or disorder.This includes third intercostal space, right sternal border 1202, fifthintercostal space, right sternal border 1204, third intercostal space,left sternal border 1206, fifth intercostal space, left sternal border1208 and apex 1210. One analog signal is sent directly to an audioamplifier and high fidelity earphones. A second analog signal is sentthrough a gain control potentiometer to an analog to digital converter.The data is digitized and displayed in real time on a monitor. Visualfeedback from the monitor allows a precise setting of the gain controlby the physician for the optimum acquisition of data. In an alternativeembodiment, an electronic strip chart is used in the precise setting ofthe gain control. The physician adjusts gain control to maximize thedynamic range of the captured signal,

In one embodiment, sounds are filtered normally. In an alternativeembodiment, sounds are filtered to de-emphasize low frequency responsesprior to being sent to either the earphones or the analog to digitalconverter. In another embodiment, frequencies DC to about 400 hertz arefiltered and de-emphasized. Data can be stored digitally, recalled forfuture analysis or transmitted to another location.

FIGS. 13a and 13b depict diastolic murmur 1302 characteristic ofcoronary artery disease. FIG. 13a depicts the data prior to signalprocessing. FIG. 13b depicts the same time series data after signalprocessing to recover diastolic murmur 1302 from the diastolic noise.

FIGS. 14a and 14b depict high resolution angiosonospectrographic images.FIG. 14a depicts a digital image of a normal heart valve sound pattern.Sound frequencies generated by mitral valve closure 1502, tricuspidvalve closure 1504, aortic valve closure 1506 and pulmonic valve closure1508 are shown. FIG. 14b depicts time series data showing bruits, orextraneous sounds, during early diastole, indicative of coronary arterydisease. Angiography confirmed 65 percent occlusion of the left anteriordescending coronary artery.

FIG. 15 depicts time series examples indicative of common abnormal heartsounds as detected though angiosonospectrographic analysis. Examplesinclude: severe aortic stenosis 1702, 1704, aortic stenosis 1706,"innocent" murmur of the elderly 1708, hypertrophic cardiomyopathy 1710,pulmonic stenosis 1712, ventricular septal defect 1714, 1716, aorticstenosis/premature ventricular contraction 1718, mitral valve prolapse1720, and atrial septal defect 1722.

The cardiac sonospectrographic analyzer is very sensitive to direction.The analyzer responds to signals perpendicular to the plane, it does notrespond to signals transverse to the plane. This aspect can be used tolocate the source of sounds. FIG. 16 presents cardiac sonospectrographicdata with frequency on the vertical axis, time on the horizontal axis,and relative amplitude plotted in different color hues (not shown).Spectrogram image 1902 represents data taken from the third intercostalspace, right sternal border. Spectrogram image 1904 represents datataken from the fifth intercostal space, right sternal border.Spectrogram image 1906 represents data taken from the third intercostalspace, left sternal border Spectrogram image 1908 represents data takenfrom the fifth intercostal space, left sternal border Spectrogram image1910 represents data taken from the apex. Each spectrogram imageindicates the presence of coronary artery disease. Spectrogram image1908 indicates stenosis is most likely present in the left anteriordescending artery. 90 percent occlusion of the left coronary artery wasconfirmed by angiography.

Although the method and apparatus of the present invention has beendescribed in detail for purpose of illustration, it is understood thatsuch detail is solely for that purpose, and variations can be madetherein by those skilled in the art without departing from the spiritand scope of the invention. The apparatus, operation and method of thepresent invention are defined by the following claims.

What is claimed is:
 1. A method of detecting cardiovascular disease ordisorder comprising:performing initialization procedures; filteringphysiologic acoustic signals, using a filter having a logarithmiccharacteristic, creating filtered physiologic acoustic signals;acquiring said filtered physiologic acoustic signals; acquiringbackground acoustic signals; subtracting said background acousticsignals from said filtered physiologic acoustic signals, creatingphysiologic data; processing the physiologic data, forming a time domainoutput and a frequency domain output; comparing the time domain outputand the frequency domain output with a reference pattern and featurelibrary; and determining if a disease modality is indicated.
 2. A methodof detecting cardiovascular disease or disorder as claimed in claim 1,wherein performing initialization further comprises:initializing system;calibrating system; selecting sensors; inputting patient parameters; andclearing buffers.
 3. A method of detecting cardiovascular disease ordisorder as claimed in claim 1, wherein electric signals are acquired inconjunction with the filtered physiologic acoustic signals.
 4. A methodof detecting cardiovascular disease or disorder as claimed in claim 1,wherein the filtered physiologic acoustic signals are in an analog form,further comprising:converting, the filtered physiologic acoustic signalsfrom the analog form to a digital form.
 5. A method of detectingcardiovascular disease or disorder as claimed in claim 1, wherein thebackground signals are in an analog form, further comprising:convertingthe background signals from the analog form to a digital form.
 6. Amethod of detecting cardiovascular disease or disorder as claimed inclaim 1, wherein processing further comprises:applying signalconditioning and time domain averaging to the physiologic data formingconditioned and averaged data; formatting the conditioned and averageddata in an array creating formatted data; transforming the formatteddata to create transformed data; integrating the conditioned andaveraged data with the transformed data, creating integrated data,wherein said integrated data has time domain components and frequencydomain components; passing the time domain components of the integrateddata through a time domain correlator and feature extraction process,creating the time domain output; and passing the frequency domaincomponents of the integrated data through a frequency domain correlatorand feature extractor, creating the frequency domain output.
 7. A methodof detecting cardiovascular disease or disorder as claimed in claim 6,further comprising:displaying the formatted data on a monitor.
 8. Amethod of detecting cardiovascular disease or disorder as claimed inclaim 6, further comprising:displaying the integrated data on a monitor.9. A method of detecting cardiovascular disease or disorder as claimedin claim 8, further comprising:updating the reference pattern andfeature library.
 10. A method of detecting cardiovascular disease ordisorder comprising:performing initialization procedures; monitoring thefrequency of acoustic physiological signals emitted by the heart andassociated blood vessels, wherein the acoustic physiological signals aredetected using a sensor assembly, the sensor assembly comprising:ahousing having a front and a back; an electronic module connected to thehousing; a shock dampener connected to the front of the housing; a meansfor mounting connected to the housing; a transducer connected to themounting means; an acoustic coupling connected to the transducer, theacoustic coupler filtering out low frequency signals according to alogarithmic characteristic; and a cover connected to the back of thehousing; processing the acoustic physiologic signals, the processingcomprising:applying signal conditioning and time domain averaging to theacoustic physiologic signals to form conditioned and averaged data;formatting the conditioned and averaged data in an array to createformatted data; transforming the formatted data to create transformeddata; integrating the conditioned and averaged data with the transformeddata, to create integrated data that has time domain components andfrequency domain components; passing the time domain components of theintegrated data through a time domain correlator and feature extractionprocess to create a time domain output; passing the frequency domaincomponents of the integrated data through a frequency domain correlatorand feature extractor, to create a frequency domain output; comparingtime domain output and the frequency domain output with a referencepattern and feature library; and determining if a disease modality isindicated.
 11. A method of detecting cardiovascular disease or disorderas claimed in claim 10, further comprising:acquiring background signals;and subtracting the background signals from the acoustic physiologicsignals.
 12. A method of detecting cardiovascular disease or disorder,the method comprising:filtering acoustic physiologic signals via anacoustic coupling having a logarithmic, high pass, filteringcharacteristic, creating filtered acoustic signals; acquiring thefiltered acoustic signals; processing the filtered acoustic signals soas to form both a time domain output and a frequency domain output;comparing the time domain output and the frequency domain output with areference pattern and feature library; and determining if acardiovascular disease or disorder is indicated.
 13. A method ofdetecting cardiovascular disease or disorder, the methodcomprising:filtering acoustic physiologic signals via an acousticcoupling having a logarithmic, high pass, filtering characteristic,creating filtered acoustic signals; acquiring the filtered acousticsignals; processing the filtered acoustic signals so as to form both atime domain output and a frequency domain output; comparing the timedomain output and the frequency domain output with a reference patternand feature library; determining if a cardiovascular disease or disorderis indicated; and contemporaneously displaying the time domain outputand the frequency domain output.